泌尿系急性出血数字减影血管造影表现与经动脉栓塞介入治疗

摘要

Objective To explore the manifestation of acute hemorrhage of urinary system in DSA and the value of interventional therapy of transarterial embolization. Methods 33 patients with acute hemorrhage of urinary system underwent DSA by subselective arterial cannulation technique, and features of DSA were observed. Transarterial embolization was applied to treat the disease by using various embolic materials. Results Hemorrhagic causes in 31 patients (94%)were confirmed, 2 patients (6%) showed unconspicuous indirect sign and diagnosed by pathologic test. All the patients underwent interventional therapy of transarterial embolization, 26 patients (79% ) ceased hematuria within 48 hours, 4 patients ( 12% ) decreased hemorrhage volume after 48 hours and ceased hemorrhage after conservative treatment and the rate of hemostasis was 91% ; 3 patients (9% ) failed after emboli-zation and ceased hematochezia following nephrectomy. There was no serious complication and recurrence of gross hematuria after a follow-up for an average of 11 months. Conclusion The application of DSA plays an important role in diagnosis and treatment of a-cute hemorrhage of urinary system. The method of intraarterial interventional therapy is less invasive, safe and effective, and it can maximally preserve the function of the related organs.%目的 探讨泌尿系急性出血的数字减影血管造影(digital substraction angiography,DSA)表现及经动脉内栓塞治疗的价值.方法 采用超选择性动脉插管技术,对泌尿系急性出血33例行DSA检查,观察其DSA表现,并选用不同的材料经动脉内栓塞治疗.结果 本组31例(94％)经DSA明确出血病因,2例(6％)表现为不典型间接征象,后经手术病理确诊.所有病例完成动脉内栓塞治疗,26例(79％)于48h内血尿停止,4例(12％ )48 h后继续尿血,但出血量较术前减少,经保守治疗后停止出血,止血率为91％；另3例(9％)栓塞后止血失败,行患肾手术切除后血尿停止.术后30例平均随访11个月,未发生严重并发症和肉眼血尿复发.结论 DSA有助于泌尿系急性出血的诊断,经动脉介入治疗是一种微创、安全、有效的治疗途径,并能够最大限度保护受损器官的功能.